Can Patients with Dementia Consent to Intimacy?

An incident at Windmill Manor involving two elderly adult patients with dementia engaging in sexual relations sheds light on a delicate and sensitive subject that is rapidly becoming an issue in nursing homes – Can patients with dementia give consent to have sex? The PBS NEWSHOUR discussed this issue with writer Bryan Gruley, on July 23, 2013, regarding what happened when the two patients, a man 78 years old and the woman 87 years old, were found by a staff member engaging in sex on Christmas 2007. Mr. Gruley wrote an article that was picked up by other news organizations that detailed what happened not only to the two patients but the Nursing Home Administrator who chose not to report the sexual activity to authorities and the Director of Nursing (DON) who lost her license to practice nursing because of the incident.

The Gruley article noted that the Nursing Home Administrator determined the incident was a mutual act and the couple with dementia engaged in consensual sexual relations. The Administrator was not required to report consensual sex if there were no physical injuries or other threats to either resident’s safety. Under both federal and state laws, elderly care facilities are required to respect residents’ rights to privacy and safety. The incident was discovered in 2010 after an investigation by the Department of Inspections and Appeals that concluded the woman had been “sexually assaulted” and Windmill Manor had failed to report it. As a result of that determination the Administrator and the Director of Nursing were fired. The nursing home was fined $47,000 and it agreed to pay a $14,500 without admitting to wrongdoing. The woman’s family also sued the facility and its corporate affiliate and the parties settled for an undisclosed amount.

Even Supreme Court Justice Sandra Day O’Connor dealt with Alzheimer’s and a major change in her relationship with her husband. Scott O’Connor recalled how after his mother moved his father, John O’Connor, into a center for Alzheimer’s patients, his mental condition deteriorated rapidly, until love blossomed with another resident identified as Kay. Scott talked about the partnership his mother lost: “They were husband and wife, lovers, best friends, you know, and that’s gone.” Scott did emphasize Justice O’Connor ‘s pleasure with her husband’s increased happiness and outgoing attitude after he initially sank into depression.

The Centers for Disease Control (CDC) estimates that the number of people 65 years old and older will rise by 101% between the years 2000 and 2030. In 2030, there will be 71 million baby boomers who are at least 65 years old. Lara Riscol, who has written about the issues of dementia, sex, and nursing homes explains that these issues can be so touchy because they include many other “hot button” issues, like the right to privacy, sex outside of marriage, sexual exploitation vs. consent, and “icky denial over our parents, the elderly, or those with disabilities desiring or doing it.” Ms. Riscol and the Gruley article both described how progressive the Hebrew Home for the Aged in Riverdale, New York, is for its policies that recognize a diagnosis of dementia does not necessarily mean the end of intimacy or a sex life for a resident.

According to the Alzheimer’s Association’s fact sheet, people with dementia can have sexual feelings that change unpredictably depending on which parts of their brain were damaged by the disease and what medication they are taking. A person with dementia can experience any of the following: more interest in sex; less interest, or no interest in sex; more or less ability to perform sexually; and changes in levels of inhibition and sexual ‘manners’ – being less sensitive to partner’s needs or becoming sexually aggressive.

The Alzheimer Association’s information sheet on “Sexuality and Dementia” states that relatives of people with dementia should respect and recognize that people with dementia are usually capable of forming new intimate relationships. Their website advises that all adults, regardless of age, have the right to make choices about their relationships and to have a private life. If those closest to a person with dementia are satisfied that their friend or relative is not physically or mentally vulnerable as the result of a relationship, and that no one else is being harmed, then relatives should not attempt to interfere.